Microincisions in cataract surgery

Refractive stability and timing of spectacle prescription following cataract surgery in myopic eyes

PURPOSE

To investigate the post-operative refractive stabilisation time and provide evidence for the optimal timing of a spectacle prescription in myopic post-cataract surgery patients.

METHODS

A total of 116 consecutive myopic cataract patients were recruited from the Zhongshan Ophthalmic Center in this prospective study. Post-operative subjective refraction was assessed after 1 week and 1 month (4-6 weeks), with the interval for the new spectacle acquisition being recorded. Visual Function Index-14 (VF-14) questionnaires were used to assess the vision-related quality of life.

RESULTS

There was no significant difference in spherical (p = 0.33), cylindrical (p = 0.65) or spherical equivalent refractions (p = 0.45) obtained 1 week and 1 month post-operatively, indicating that subjects achieved refractive stability within 1 week. In subgroups having differing age and axial lengths, there were also no significant differences between the 1 week and 1 month findings. The spherical equivalent refractive shift between 1 week and 1 month was significantly correlated with the post-operative prediction error (R = 0.35; p < 0.001). Only five (4.3%) out of 116 patients obtained new spectacles 1 week post-surgery. The VF-14 values improved from 85.77 ± 7.24 to 90.45 ± 5.39 after acquiring new spectacles (p < 0.01).

CONCLUSIONS

The stabilisation of subjective refraction occurred within 1 week in myopic cataract patients. Shortening the interval before prescribing a new spectacle prescription is recommended for myopic patients following cataract surgery to improve their vision-related quality of life.

Impact of a handpiece with a built-in fluidics pressure sensor on phacoemulsification: a multicentre prospective comparative study

OBJECTIVE

We assessed whether the immediate pressure adjustments provided by a phacoemulsification handpiece with a built-in pressure sensor (Active Sentry, AS) could decrease the amount of energy delivered in the eye during cataract surgery.

METHODS AND ANALYSIS

The Study of Active Sentry in Cataract Surgery was a multicentre prospective clinical trial. The Centurion system (Alcon Labs) was used and we compared phacoemulsifications performed with the AS handpiece with procedures using a sensor placed in the phacoemulsifier (non-AS). The primary outcome measure was the cumulative dissipated energy (CDE) used during the procedures. The secondary outcome measures were the total, longitudinal and torsional ultrasound (US) times, the duration of the surgery and the amount of fluid used during the surgeries.

RESULTS

The study analysed 1432 (800 AS and 632 non-AS) procedures. The mean patient age was 72.4±10.0 years. The median CDE was respectively 6.3 (IQR 3.5-9.9) and 6.7 (IQR 4.5-11.5) with and without AS (p=0.0001). The median US time was, respectively, 48.0 s (IQR 34.0-68.0) and 55.0 s (IQR 38.0-80.0) with and without AS (p<0.0001). Torsional and longitudinal US times were reduced with AS. The median duration of the procedure was, respectively, 9.0 min (IQR 7.0-12.0) and 10.0 min (IQR 7.0-13.0) (p=0.0002) with and without AS. The median balanced salt solution volume used was 52.0 cm3 (IQR 41.0-72.0) and 57.0 cm3 (IQR 42.0-81.0) with and without AS (p=0.0018).

CONCLUSION

The phacoemulsifications performed with a pressure sensor built in the handpiece delivered less energy in the eye and were shorter.

TRIAL REGISTRATION NUMBER

NCT04732351.

Clear corneal incision, an important step in modern cataract surgery: a review

A clear corneal incision (CCI) is the most commonly used entrance site in modern phacoemulsification cataract surgery. Despite some initial concerns about increased endophthalmitis rates through a self-sealing CCI, recent literature suggests that the risk of infection with proper wound construction and all other necessary precautions is minimal. The technique of creating a clear corneal incision has, with recent developments in corneal imaging, undergone critical appraisal leading to a better understanding of incision architecture. Many surgeons operate through smaller incisions, and they have a wide choice of surgical instruments to create their corneal incisions. The aim of this review is to discuss the history and the current status of clear corneal incision creation, the design and materials of surgical blades, and the current trends in manufacturing and sustainability. Although disposable instruments have some advantages and are very popular, recycling, if possible, and avoiding unnecessary plastic waste are important considerations. In any case, the step of CCI is a small one for the surgeon, but a big one for the eye. That is why it has to be done with the utmost precision and in-depth knowledge is important.

Enlargement of main corneal incision: clinical intraindividual comparison of two preloaded intraocular lens injectors

PURPOSE

To compare the enlargement of the clear corneal incision from IOL implantation with 2 different intraocular lens (IOL) injectors: the AutonoMe preloaded with the Clareon IOL and the Multisert preloaded with the Vivinex IOL.

SETTING

The David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany.

DESIGN

Prospective randomized clinical comparative study.

METHODS

96 eyes of 48 patients with cataract were intraindividually randomized to treatment with 1 of the 2 injectors. For Multisert eyes, the insert shield (IS) was used in the advanced position in 23 eyes. The initial incision was 2.2 mm, and intraoperative measurements of the incision size were made before and after IOL injection. 3 months postoperatively, keratometry and uncorrected (UDVA) and corrected (CDVA) distance visual acuities were assessed.

RESULTS

Results are reported for 96 eyes of 48 patients. The mean incision enlargement was 0.213 ± 0.068 mm in the Multisert with the IS group, 0.265 ± 0.055 mm in the fellow eyes (AutonoMe) ( P < .05), 0.272 ± 0.060 mm in Multisert eyes treated without the IS, and 0.296 ± 0.066 mm for the fellow eyes (AutonoMe) ( P > .05). The mean absolute surgically induced astigmatism was 0.42 ± 0.23 diopters (D), 0.50 ± 0.25 D, and 0.44 ± 0.18 D in the Multisert with the IS, Multisert without the IS, and AutonoMe group, respectively ( P > .05). The UDVA and CDVA were comparable in all groups.

CONCLUSIONS

The Multisert was associated with less wound enlargement than the AutonoMe. All groups had comparable functional outcomes. Therefore, the observed difference in incision enlargement may be of limited clinical relevance.

Corneal Endothelial Cell Loss After Endocapsular and Supracapsular Phacoemulsification: The PERCEPOLIS Randomized Clinical Trial

PURPOSE

Subluxation techniques are superior to divide-and-conquer in procedure duration, pain, and ultrasound quantity, but their safety in endothelial cell loss (ECL) is unclear. This randomized single-blind noninferiority clinical trial aimed to determine whether subluxation supracapsular phacoemulsification techniques are inferior to a reference endocapsular technique (divide-and-conquer) regarding postoperative corneal ECL.

METHODS

Patients (aged18 years or older) with greater than +0.2 logarithm of the minimum angle of resolution best spectacle-corrected visual acuity and normal to severe density cataract were randomized to subluxation or divide-and-conquer phacoemulsification in 2015 to 2016. Follow-up with ophthalmic tests was conducted on day 4 and months 1, 3, and 12. The primary study outcome was ECL at all time points. Secondary study end points were operative variables, including effective phaco time and procedure duration. A clinically relevant noninferiority ECL limit was established on the basis of the literature.

RESULTS

In total, 292 patients (mean age, 73 yrs; 59% female) were randomized and underwent subluxation (n = 148) or divide-and-conquer (n = 144). Day 4 and month 1, 3, and 12 data were available for 243, 270, 275, and 198 patients, respectively. The unexpectedly high dropout at 12 months meant that the 12-month ECL data could only be assessed qualitatively. Surgery was successful in all patients. Subluxation was noninferior to divide-and-conquer in ECL. Effective phaco times were similar, but subluxation associated with shorter procedure duration.

CONCLUSIONS

The subluxation technique was noninferior to divide-and-conquer regarding postoperative ECL, at least in the first 3 months, and associated with reduced intervention time. Subluxation techniques may be suitable alternatives to endocapsular techniques.Clinical Trial Registration-URL: ClinicalTrials.gov. Unique identifier: NCT02535819.

Corneal surgically induced astigmatism in resident surgeons

To evaluate surgically induced astigmatism (SIA) in resident surgeons in their first year of performing cataract surgery, a retrospective study was conducted involving three resident physicians from July 1, 2019, to June 30, 2020. Preoperative and postoperative corneal measurements were taken with the IOLMaster 500 and Pentacam. Mean SIA and centroid were determined with the Koch-Wang Excel spreadsheet. A total of 135 eyes were operated on, with Resident A performing 67 surgeries; Resident B, 60 surgeries; and Resident C, 8 surgeries. Resident A's IOLMaster results revealed centroid values of 0.08 D @ 91° ± 0.37 diopters (D) and 0.16D @ 82° ± 0.32D and Pentacam centroid values of 0.13D @ 100° ± 0.34D and 0.24D @ 93° ± 0.38D for right and left eyes, respectively. Resident B's IOLMaster results revealed centroid values of 0.23D @ 102° ± 0.23D and 0.29D @ 110° ± 0.26D and Pentacam centroid values of 0.21D @ 124° ± 0.33D and 0.17D @ 103° ± 0.51D for right and left eyes, respectively. In conclusion, centroid values of SIA with junior surgeons were more than the proposed established values, but likely not clinically significant, with at most a difference of <0.17D in the spectacle plane. To achieve more accurate refractive outcomes in toric intraocular lenses, all residents should calculate their personal SIA early in their surgical career.

Experimental evaluation of the injection force exerted in intraocular lens delivery with syringe-type injectors

The process of intraocular lens (IOL) delivery within the capsular bag during cataract surgery is crucial, as the integrity of the IOL, the injector and the ocular structures should be preserved at all times. This study aims to obtain the main parameters that affect the injection force exerted in the ejection of an intraocular lens (IOL) through syringe-type injectors. For that purpose, ejection tests were carried out in vitro, measuring the resistance force throughout the entire delivery process. The effect of IOL material, haptic design, IOL thickest area and ophthalmic viscosurgical device (OVD) was studied by ejecting seven IOLs with four syringe-type injectors of different sizes, 3.0, 2.2 and 1.8 mm. In all injectors, plate hydrophilic IOLs present the lowest resistance forces; hydrated C-loop hydrophobic IOLs present higher forces and the C-loop hydrophobic IOL in dry conditions presents the highest resistance forces. All IOLs could be properly delivered with an injector size of 2.2 mm, making injector sizes of 3.0 mm outdated. The injector size of 1.8 mm damaged several IOLs. IOL material and cartridge nozzle size were the most influential parameters in IOL delivery. IOL thickest area was also relevant but in a lesser extent whereas IOL haptic design was not as relevant.

Optimization of femtosecond laser-constructed clear corneal wound sealability for cataract surgery

PURPOSE

To compare the sealability of femtosecond laser (FSL)-assisted corneal incisions (CIs) with that of triplanar manual (M)-CIs and to determine FSL wound parameters minimizing leakage.

SETTING

Private practice.

DESIGN

Phase IV, single-surgeon, retrospective cohort study.

METHODS

One eye per patient was included. Two groups defined by the main wound (FSL-CI or M-CI) were compared for leakage, inferred by placement of a suture at the end of surgery. Leakage in FSL-CIs was analyzed as a function of customizable wound parameters: anterior plane depth (APD), posterior plane depth (PPD), anterior side-cut angle (ASCA), and posterior side-cut angle (PSCA). The risk of leakage of FSL-CIs with optimal and nonoptimal parameters was further compared with that of M-CIs.

RESULTS

A total of 1100 eyes (757 [68.8%] FSL-CI; 343 [31.2%] M-CI) were included. Wound leakage occurred in 133 FSL-CI (17.6%) and 30 M-CI eyes (8.7%) (P < .001). FSL wound parameters associated with the lowest risk of leakage were 60% APD, 70% PPD, 120 degrees ASCA, and 70 degrees PSCA. FSL-CIs constructed with at least 3 optimal parameters (60% APD, 70% PPD, and 120 degrees ASCA) had a similar risk of leakage to M-CIs (odds ratio [OR], 1.1; 95% CI, 0.5-2.3). FSL-CIs with suboptimal parameters had twice the risk of leakage of M-CIs (OR, 2.0; 95% CI, 1.1-3.8).

CONCLUSIONS

Overall, FSL-CIs leaked more than M-CIs. However, FSL-CIs with optimized wound profiles had an equivalent risk of leakage to M-CIs. Wound parameter customization is an asset of FSL technology that allows optimization of FSL-CI sealability.

Evaluation of the Cataract Surgery 2018 Survey in Terms of Achieving Refractive Cataract Surgery Targets

Objectives

The aim of this study was to show at what rate the technological equipment used in cataract surgery by Turkish ophthalmologists and their knowledge are reflected in practice and how up to date they are.

Materials and Methods

A questionnaire conducted using SurveyMonkey was used to evaluate the answers to 17 questions from 823 members of the Turkish Ophthalmological Association. Results were evaluated in subgroups according to the participants' age, occupational status, institutions, and whether they conducted relevant academic activities, and the data were compared as inadequate, standard, and contemporary approaches according to the determined criteria.

Results

Optical biometry devices were used at rates of 77.7% and 67.3% for intraocular lens (IOL) power calculations and keratometric measurements in preparation for cataract surgery, respectively. For IOL power calculation, third-generation formulas, especially the SRK-T, were used most commonly (46.2%), followed by second-generation formulas (21.9%), and fourth/fifth-generation formulas and multiple evaluations for different axial lengths (31.9%). The most common incision size was 2.8 mm (51.6%), while the percentage of 2.2 mm and shorter incisions considered to be neutral in terms of surgically induced astigmatism was 18.8%. When selecting incision location, approaches to reduce corneal astigmatism were reported by 28.9%, neutral approaches by 26.2%, and insensitive approaches by 44.9%. Additionally, 55.6% of participants never implanted toric IOLs and 50.7% did not use presbyopia-correcting IOLs. The proportion of surgeons who have experience with femtosecond laser-assisted cataract surgery was 10.3% and the rate of intracameral antibiotic injection at the end of the operation was 89.4%.

Conclusion

It was seen that Turkish cataract surgeons were able to use high technology for surgical preparation and surgery at high rates, but this was not reflected in practice at same rate in terms of achieving contemporary standards of refractive cataract surgery.

Uveal and capsular biocompatibility of a new hydrophobic acrylic microincision intraocular lens

PURPOSE

To evaluate uveal biocompatibility and capsular bag opacification of a new hydrophobic acrylic microincision intraocular lens (IOL) in comparison with a commercially available 1-piece hydrophobic acrylic IOL.

SETTING

John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.

DESIGN

Experimental study.

METHODS

Eight New Zealand rabbits underwent bilateral phacoemulsification and implantation of the preloaded Nanex multiSert IOL in one eye and a commercially available preloaded lens (AcrySof IQ in UltraSert, model AU00T0) in the contralateral eye. A slitlamp examination was performed weekly for 4 weeks. The rabbits were then killed humanely and their globes enucleated. Capsular bag opacification was assessed from the Miyake-Apple view, and the eyes were subjected to histopathologic evaluation.

RESULTS

Postoperative inflammatory reactions were similar between the test and control eyes in the 8 New Zealand rabbits. The mean postmortem central posterior capsule opacification (PCO) was 0.93 ± 0.73 in the test group and 1.19 ± 0.53 in the control group. The mean postmortem peripheral PCO was 1.75 ± 0.92 in the test group and 2.06 ± 0.77 in the control group. Central and peripheral PCO scores were not statistically different between the test and control groups (P = .41 and P = .35, respectively, 2-tailed t test: paired 2-sample for means).

CONCLUSIONS

A new 1-piece hydrophobic acrylic microincision IOL incorporating an ultraviolet-ozone treatment on the posterior surface performed similarly to a commercially available 1-piece hydrophobic acrylic IOL in terms of uveal and capsular biocompatibility in the rabbit model. To our knowledge, this is the first hydrophobic acrylic microincision IOL to demonstrate similar PCO performance when compared with a conventional, commercially available IOL.

Intraocular Lenses: Overview of Designs, Materials, and Pathophysiologic Features

This article provides an overview of intraocular lenses (IOLs) currently used in cataract surgery. Aspects presented include design features related to IOL construction and sites of fixation; optic, filter, and haptic materials; as well as pathophysiologic features of uveal biocompatibility, capsular biocompatibility, and postoperative IOL opacification. This overview also includes supplementary (add-on; piggyback) lenses implanted in eyes that are already pseudophakic and considerations on IOLs used in the pediatric population. Different IOLs are made available to surgeons each year, including lenses with increasingly complex design characteristics owing to advancements in manufacturing and surgical techniques.

Comparison of visual outcomes after implantation of AtLisa tri 839 MP and Symfony intraocular lenses

Purpose

To compare visual outcomes after implantation of AtLisa tri 839 MP and Symfony intraocular lenses (IOLs).

Methods

All subjects underwent sequential bilateral cataract extraction with AtLisa tri 839 MP or Symfony IOL implantation. The design is prospective case series. Each group consists of 20 patients (40 eyes). At 1 year postoperatively, the following parameters were analysed: binocular uncorrected visual acuity (log MAR): for distance (UDVA) at 4 m, for intermediate distances (UIVA) at 60, 70, 80 cm and for near (UNVA) at 40 cm, defocus curve, mesopic and photopic contrast sensitivities (CSs), spectacle independence, visual function test questionnaire modified VFQ-25), photopic phenomena and postoperative complications.

Results

In the AtLisa tri 839 MP group, the mean binocular UNVA and UIVA were significantly better than in the Symfony group (UNVA: − 0.01 ± 0.04 vs. 0.21 ± 0.15; p = 0.000; 60 cm UIVA: − 0.01 ± 0.04 vs. 0.09 ± 0.09, p = 0.001; 70 cm UIVA − 0.05 ± 0.06 vs. 0.11 ± 0.08, p = 0.002; 80 cm UIVA − 0.01 ± 0.06 vs. 0.15 ± 0.08, p = 0.019). There were no significant between-group differences in the mean binocular UDVA and CS, with one exception: the mean binocular distance CS (18 cpd) under mesopic conditions was significantly better in the Symfony group than in the AtLisa tri 839 MP group (1.39 ± 0.22 vs. 1.17 ± 0.27; p = 0.015). The defocus curve analysis revealed significant between-group differences at vergences of 2.0 to − 4.0 D (p < 0.05), except for 2.0, 1.0, 0 and − 1.5. All subjects in AtLisa tri 839 MP group and 18 subjects (90%) in Symfony group were spectacle independent. Patients from both groups highly rated their overall vision quality in the VFQ-25 (1.67 ± 0.47 vs. 1.85 ± 0.5 in the Symfony and AtLisa tri 839 MP group, respectively, p = NS). The scores for daytime driving (1.00 ± 0.00 vs. 1.21 ± 0.36; p = 0.002), night driving (1.57 ± 0.55 vs. 2.13 ± 1.15; p = 0.027) and difficult situation driving (1.14 ± 0.31 vs. 1.53 ± 0.56; p = 0.049) were significantly better in the AtLisa tri 839 MP group than in the Symfony group. The incidence and perception level of halo and glare were significantly reduced (p = 0.00) in the Symfony group as compared to the AtLisa tri 839 MP group. The postoperative course was uneventful in all subjects.

Conclusions

Visual outcomes achieved with both IOLs are comparable. In both groups, 90% of patients achieved spectacle independence. Whereas the AtLisa tri 839 MP IOL implantation was associated with slightly better intermediate distance VA and significantly better near VA, photic phenomena were less perceived by patients with Symfony IOLs.

Influence of corneal diameter on surgically induced astigmatism in small-incision cataract surgery

OBJECTIVE

Clear corneal incisions (CCI) in cataract surgery create a variable amount of surgically induced astigmatism (SIA). As refractive outcomes become increasingly important, it is necessary to understand factors that impact SIA and refractive surprises. In this study, we evaluate the effect of horizontal corneal diameter (white-to-white, WTW) on SIA in 2.2 mm small-incision cataract surgery.

DESIGN

Prospective study at an academic-university-based outpatient clinic (Duke Eye Center).

PARTICIPANTS

We enrolled adults ≥18 years of age without prior corneal surgery or corneal pathology undergoing cataract surgery with a single surgeon (R.R.V.).

METHODS

All surgeries were uncomplicated and performed through a manually constructed, limbal, temporal, or superotemporal 2.2 mm CCI. Enrolled participants received standard-of-care evaluations and postoperative management. SIA was calculated at the first postoperative month using the Jaffe and Clayman vector analysis equation.

RESULTS

We enrolled 43 subjects (55 eyes) with a mean age of 71 years with WTW corneal diameter values ranging from 11.34 to 12.99 mm obtained from Lenstar^® (Haag-Streit Group, Koeniz, Switzerland). Postoperative SIA ranged from 0.072 to 1.6 D (mean 0.47 D, standard deviation 0.33 D). SIA was plotted against WTW and best fit to a linear regression model with a slope of -0.056 and an R² value of 0.006.

CONCLUSIONS

In this prospective study, WTW diameter had minimal effects on the SIA in uncomplicated small-incisional cataract surgery through a 2.2 mm temporal or superotemporal CCI with a single surgeon. Our findings suggest that corneal diameter does not play a clinically significant role in this population undergoing small-incisional cataract surgery.

Comparison of Wound Sealability Between Femtosecond Laser-Constructed and Manual Clear Corneal Incisions in Patients Undergoing Cataract Surgery: A Pilot Study

PURPOSE

To compare the sealability of femtosecond laser-constructed and manual clear corneal incisions (CCIs) in patients undergoing cataract surgery.

METHODS

This prospective, randomized study included 62 eyes of 62 patients with cataract grade 1 to 2 (LOCS scale). The patients were randomly assigned (1:1) for creation of either manual CCI (with a 2.4-mm keratome) or femtosecond laser-assisted CCI (LENSAR, Inc., Orlando, FL) (31 eyes in each group) before undergoing femtosecond laser-assisted cataract surgery. Wound sealability was assessed as grade 1, 2, or 3 (1: need to reform anterior chamber and hydrate wound at end of surgery; 2: need to reform anterior chamber only; 3: formed anterior chamber, no hydration or anterior chamber reformation necessary).

RESULTS

The nuclear sclerosis grade, cumulative dissipated energy and phacoemulsification time were comparable between the two groups. No complications were experienced in any of the patients. The mean wound sealability for the femtosecond laser group (2.35 ± 0.84) was statistically significantly better in comparison to the manual group (1.32 ± 0.65) (P < .001). At the end of the surgery, 22.6% (n = 7) of eyes in the femtosecond laser group needed reformation of the anterior chamber and hydration of the wound compared to 77.4% (n = 24) of eyes in the manual group. Conversely, 58.1% (n = 18) of eyes in the femtosecond laser group compared to 9.7% (n = 3) of eyes in the manual group were observed to have a formed anterior chamber.

CONCLUSIONS

Femtosecond laser-created CCIs had significantly better wound sealability compared to those created with a metal keratome. [J Refract Surg. 2017;33(11):744-748.].

A comparison of surgical efficacy between a 1.8-mm microincision and 3.2-mm and 5.5-mm incisions for phacoemulsification

Phacoemulsification is a commonly used surgical method in cataract surgery. This paper observes and compares the surgical efficacy of three incisions of different length for phacoemulsification to identify the optimal method for cataract surgery. Ninety patients were enrolled in the present study and divided into three groups. The 1.8-mm group received Bausch & Lomb MI60 foldable intraocular lens (IOL) implantation (n=30), 3.2-mm group received Bausch & Lomb Akreos AO foldable lens implantation (n=30), and 5.5-mm group received Alcon TYPE 05 rigid IOL implantation (n=30). Visual acuity, Oculyzer-based anterior segment analysis, and corneal endothelial cell count before surgery, and 3, 7, 30, and 90d after surgery were recorded and compared. Pseudophakic accommodation three days, one week, one month, and three months after surgery was determined. Intraoperative ultrasound time and ultrasonic energy were recorded. It was finally concluded that for phacoemulsification with the same phaco tip, a 1.8-mm microincision can lead to quicker recovery of visual acuity, more stable astigmatism, and higher pseudophakic accommodation than conventional incision.

Comparison of cumulative dissipated energy delivered by active-fluidic pressure control phacoemulsification system versus gravity-fluidics

PURPOSE

To compare the cumulative dissipated energy (CDE), aspiration time and estimated aspiration fluid utilized during phacoemulsification cataract surgery using two phacoemulsification systems .

METHODS

A total of 164 consecutive eyes of 164 patients undergoing cataract surgery, 82 in the active-fluidics group and 82 in the gravity-fluidics group were enrolled in this study. Cataracts graded NII to NIII using LOCS II were included. Each subject was randomly assigned to one of the two platforms with a specific configuration: the active-fluidics Centurion ^® phacoemulsification system or the gravity-fluidics Infiniti ^® Vision System. CDE, aspiration time (AT) and the mean estimated aspiration fluid (EAF) were registered and compared.

RESULTS

A mean age of 68.3 ± 9.8 years was found (range 57-92 years), and no significant difference was evident between both groups. A positive correlation between the CDE values obtained by both platforms was verified (r = 0.271, R ² = 0.073, P = 0.013). Similarly, a significant correlation was evidenced for the EAF (r = 0.334, R ² = 0.112, P = 0.046) and AT values (r = 0.156, R ² = 0.024, P = 0.161). A statistically significantly lower CDE count, aspiration time and estimated fluid were obtained using the active-fluidics configuration when compared to the gravity-fluidics configuration by 19.29, 12.10 and 9.29%, respectively (P = 0.001, P < 0.0001 and P = 0.001).

CONCLUSIONS

The active-fluidics Centurion ^® phacoemulsification system achieved higher surgical efficiency than the gravity-fluidics Infiniti ^® IP system for NII and NIII cataracts.

New Technique of Femtosecond Laser-Assisted Intracorneal Ring Segment Implantation

PURPOSE

To describe a new technique of femtosecond laser-assisted intracorneal ring segment implantation.

METHODS

The study included 6 eyes of 5 patients. Software of the LDV Z6 femtosecond laser was modified to create a 110-degree reverse side cut between the corneal surface and incision instead of the conventional 90 degree angle (which changed the angle between the incision and tunnel from conventional 90-70 degrees) and 2 disjointed tunnels separated by 10 degrees arc length at the proximal and distal ends.

RESULTS

One-year postoperatively, there were no cases of segment extrusion or touch/overlap. Anterior segment optical coherence tomography showed appropriate position of the rings in all eyes postoperatively. Improvement was also found in visual, refractive, keratometric, and asphericity parameters.

CONCLUSIONS

The results of this pilot study are promising. A comparative prospective study with more eyes and longer follow-up may confirm whether this technique is better than the conventional femtosecond laser-assisted one.

Long-term follow-up for bimanual microincision cataract surgery: comparison of results obtained by surgeons in training and experienced surgeons

Purpose

To determine the efficacy of bimanual microincision cataract surgery (B-MICS) performed by surgeons in training, evaluating clinical results, posterior capsule opacification (PCO) incidence, and clear corneal incision (CCI) architecture in a long-term follow-up and comparing results with those obtained by experienced surgeons.

Patients and methods

Eighty eyes of 62 patients operated on by three surgeons in training who used B-MICS technique for the first time were included in the study (Group A). Eighty eyes of 59 patients who underwent B-MICS by three experienced surgeons were included as a control group (Group B). Best corrected visual acuity, astigmatism, corneal pachymetry, and endothelial cell count were evaluated before surgery and at 1 month and 18 months after surgery. Anterior segment optical coherence tomography images were obtained to study the morphology of CCIs. PCO incidence was evaluated using EPCO2000 software.

Results

Out of 160 surgeries included in the study, mean best-corrected visual acuity improvement at 18 months was 0.343±0.246 logMAR for Group A, and 0.388±0.175 logMAR for Group B, respectively. We found no statistically significant induced astigmatism nor corneal pachymetry changes in either group, while we noticed a statistically significant endothelial cell loss postoperatively in both groups (P<0.05). In Group A, mean PCO score was 0.163±0.196, while for Group B, it was 0.057±0.132 (P=0.0025). Mean length and inclination of the CCIs for Group A and Group B were, respectively, 1,358±175 µm and 1,437±256 µm and 141.8°±6.4° and 148.7°±5.1°. As regards corneal architecture in the 320 CCIs considered, we found posterior wound retractions and endothelial gaps, respectively, 9.8% and 11.6% for Group A and 7.8% and 10.8% for Group B.

Conclusion

B-MICS performed by surgeons in training is an effective surgical technique even when assessed after a long-term follow-up. PCO incidence resulted in being higher for less experienced surgeons. Corneal incisions were shorter and less angled in surgeons in training in comparison with results obtained by expert surgeons.

Nanotechnology for the Prevention and Treatment of Cataract

PURPOSE

The purpose of this article was to review recent advances in the applications of nanotechnology in cataract treatment and prevention strategies.

DESIGN

A literature review on the use of nanotechnology for the prevention and treatment of cataract was done.

METHODS

Research articles about nanotechnology-based treatments and prevention technologies for cataract were searched on Web of Science, and the most recent advances were reported.

RESULTS

Nonsteroid anti-inflammatory drugs, natural antioxidants, biologic and chemical chaperones, and chaperones such as molecules have found great application in preventing and treating cataracts. Current scientific research on new treatment strategies, which focuses on the biochemical basis of the disease, will likely result in new anticataract agents. However, none of the drug formulations will be approved for use unless efficient delivery is promised. Nanoparticle engineering together with biomimetic strategies enable the development of next-generation, more efficient, less complex, and personalized treatments.

CONCLUSIONS

The only currently available treatment for cataracts, surgical replacement of the opacified lens, is not an easily accessible option in developing countries. New treatment strategies based on topical drugs would enable treatment to reach massive populations facing the threat of blindness and more effectively deal with the postsurgical complications. Nanotechnology plays a key role in improving drug delivery systems with enhanced controlled release, targeted delivery, and bioavailability to overcome diffusion limitations in the eye.

Corneal injection track: an unusual complication of intraocular lens implantation and review

Phacoemulsification is the main gold standard for cataract operation in the developed world together with foldable intraocular lens (IOL) implantation by injection, allowing for stable wound construction and less postoperative astigmatism. It is a safe procedure with high success rate with the advancement in machines, improvement of IOL injection systems and further maturation of surgeons' techniques. Despite the large number of operations performed every day, foldable IOL injection leading to an intra-stromal corneal track is a very rare complication. We report a case of this unusual finding in a 70-year-old gentleman who has undergone cataract operation in November 2011 in our hospital and will review on the complications related to foldable IOL injection.